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How Lupus Affects the Skin

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Updated May 16, 2014

People with lupus know the disease can affect various parts of their body, both inside and out, in a variety of ways. Though lupus is known to affect the joints, kidneys, heart and lungs, more often than not, one of the clearest signs that a person has developed the disease is the way it affects the skin. These abnormal skin conditions are referred to as skin –- or cutaneous –- disease.

Chronic cutaneous (discoid lupus), subacute cutaneous, and acute cutaneous are the three main types of lupus skin disease.

However, there are other skin diseases that can occur in lupus and in other autoimmune diseases. Those include vasculitis and alopecia (hair loss). Mucosal ulcers in the nose or mouths are another common complaint of those with lupus. Like other symptoms, the ulcers can come and go as the disease flares.

And just to make it more complicated, lupus types range across a broad spectrum. Some people with discoid lupus may never develop the systemic version of the disease (systemic lupus erythematosus). And those with subacute cutaneous lupus may develop arthritis, for example, while those with acute cutaneous lupus typically are people with active SLE.

Chronic cutaneous lupus (Discoid Lupus):

Discoid lupus distinguishes itself from systemic lupus erythematosus through the severity of rashes. In SLE, a malar rash in a butterfly pattern may appear across the nose and cheeks of the patients, or red rashes may develop in reaction to sunlight. But in discoid lupus, chronic inflammatory sores develop on the face, ears, scalp and on other body areas.

When lesions become very thick scales, they are referred to as “hypertrophic” (thickened) or “verrucous” (wart-like) discoid lesions. Lesions with firm lumps in the fatty tissue underlying the skin are called “lupus profundus” or “lupus erythematosus panniculitis.”

Some patients have scarring on the scalp, making hair re-growth impossible in those areas. A skin biopsy is often used to diagnose discoid lupus in these cases, as other diseases can look similar but have different treatments.

Lupus can affect many organs besides the skin. When it does, it's called SLE.. About 10 percent of discoid lupus patients develop SLE. As with other forms of lupus, it is a case of the body attacking normal skin. The exact cause of this form is unknown, although women are more likely to have it and it has been shown to run in families. Cigarette smoking and sunlight have been shown to exacerbate the condition.

Lesions can be treated with the application of corticosteroid creams, ointments, gels, tapes, and solutions.

Subacute cutaneous lupus:

Subacute cutaneous lesions are defined by their two clinical forms:

  • A psoriasis-like lesion with red scaly patches on the arms, shoulders, neck, and trunk and fewer patches on the face.
  • A red ring-shaped lesion with a slight scale on the edges.

Those with subacute cutaneous lupus should avoid natural sunlight and tanning beds as this photosensitivity will exacerbate the disease.

As with discoid lupus, lesions can be treated with the application of corticosteroid creams, ointments, gels, tapes, and solutions.

Acute cutaneous lupus:

Lesions associated with acute cutaneous lupus appear as flattened areas of red skin on the face, reminiscent of a sunburn – the tell-tale butterfly rash. These lesions can appear on the arms, legs, and body, and are photosensitive. Though they may discolor the skin, they do not scar. Those with active SLE –- those having a flare – often display these lesions.

Acute cutaneous lupus, since it often occurs with body-wide lupus (SLE) is often treated with drugs such as prednisone, or in combination with other immunosuppressants.

Vasculitis:

This condition is inflammation of the lining of the blood vessels, which appears as red bumps or spots on the skin, commonly the lower legs, occurs because of damage to the blood vessels in the skin. Occasionally, larger knots (nodules) and ulcers can develop, and the disease can be hive-like or produce small red or purple lines in fingernail folds or on fingertips. This usually occurs in patients with active SLE, but one does not have to have lupus to have vasculitis.

Alopecia (hair loss):

Severe lupus flares can often results in fragile hair that breaks easily, or temporary hair loss, which is eventually replaced by new hair growth. Broken hair often looks ragged and is sometimes termed “lupus hair.” Of note, when discoid lupus involves the scalp, prompt treatment is encouraged, since hair follicle damage can cause irreversible hair loss.

Treatment reminder

Lupus patients should be aware of dangers of prolonged exposure to sunlight, tanning booths and certain light bulbs (photosensitivity). To protect oneself from the sun, sunscreens with SPFs above 30 that protect against both UVA and UVB rays should be applied every two hours. Consider appropriate clothing that can protect against the sun, as well.

Consult a dermatologist for further information on choosing the right treatment, as well as proper selection and use of sunscreens.

Sources:Lupus and the Skin. American Academy of Dermatology. December 2006.
Symptoms The Lupus Foundation of America. June 2007.

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